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Questions remain about health reform's impact

May 1, 2010
by Gary A. Enos, Editor
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After that initial burst of enthusiasm following the enactment of health reform legislation in March, has the addiction profession's reaction to the landmark law's adoption seemed a little muted?

In the weeks following President Obama's signing of the Patient Protection and Affordable Care Act, field professionals with whom I spoke indicated at least some unrest along with the excitement over the law's passage. Much of this appears to reflect uncertainty about how addiction services will be structured in a healthcare system destined to become more integrated.

One consultant in April even used the phrase “in the dark” when describing how addiction professionals were reacting to the new law's adoption. He believes care providers will have to place a renewed emphasis on their programs' results in order for their funding to continue. And few observers believe that the combination of health reform and parity laws will simply eliminate all payer restrictions on the scope of addiction treatment.

It isn't difficult to understand why thoughts of a more unified, coordinated healthcare system tend to generate anxiety among addiction professionals and the agencies that employ them. Consider the contrast with the mental health provider community. Leading national organizations in mental health for years have emphasized integration with general medicine in their outreach to members. Motivated by data showing improved outcomes when mental health needs are identified as part of managing chronic disease, segments of that field have aggressively tested models for integration with primary care.

So for many professionals in the mental health community, today's discussion of a “medical home” that will serve as consumers' access point for integrated care already resonates. Yet in the addiction arena, the specialty treatment sector hasn't embraced the language of integration to as great an extent. Topics such as primary care screening for substance use problems have been talked about, but there remains uncertainty over whether those initiatives will expand or shrink service opportunities for specialty addiction treatment providers.

None of this, of course, diminishes the many positives we have conveyed about health reform. The law's inclusion of equitable addiction services in the required benefit packages for new Medicaid enrollees and new private insurance customers is an accomplishment that cannot be underemphasized. Other initiatives in areas such as behavioral workforce development incentives and support for prevention programming also could lift the field.

So it is not that the initial euphoria has given way to cynicism, but just to a sense that we aren't close to answering all the questions about how this will play out. Just as one of the first observations after parity took effect was that addiction benefits in some health plans actually were reduced to fall in line with comparable provisions in general health, there could be plenty of unexpected consequences from the implementation of health reform-a process that will take years to unfold.

As part of our continued coverage of this topic in print and at, we'd like to hear from you about your expectations for the new law and where addiction treatment fits into the overall picture. As always, you can reach me by phone at (401) 353-1316 or by e-mail at the address below.

Gary A. Enos, Editor Addiction Professional 2010 May-June;8(3):6